Healthcare Provider Details

I. General information

NPI: 1184802571
Provider Name (Legal Business Name): KALISPELL REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 10/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 COMMONS LOOP
KALISPELL MT
59901-1912
US

IV. Provider business mailing address

195 COMMONS LOOP
KALISPELL MT
59901-1912
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-0303
  • Fax: 406-752-0314
Mailing address:
  • Phone: 406-752-0303
  • Fax: 406-752-0314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number15471
License Number StateMT

VIII. Authorized Official

Name: PAMELA S ROBERTSON
Title or Position: PRESIDENT/CHIEF EXECUTIVE OFFICER
Credential:
Phone: 406-752-1724